Cognitive impairment in congestive heart failure?

Congestive cardiac failure ranks second after atrial fibrillation in cardiogenic stroke risk, with a two- to threefold relative risk.1 This relative risk is over fourfold among those 50 to 59 years of age, diminishing to about 1.5 by age 80 to 89 years. As in atrial fibrillation, stroke in cardiac failure is predominantly cardioembolic and, in the case of multiple emboli, may lead to dementia.2 The cause of these emboli is likely systolic dysfunction of the left ventricle causing an increased end diastolic volume and stasis, predisposing to thrombus formation (12% of patients with cardiomyopathy have left ventricular thrombi3). In patients with heart failure, ejection fraction is the most important predictor of risk: low ejection fraction is a risk factor for cerebral infarction4,5⇓ and ventricular thrombus formation.3 In addition to multiple cerebral emboli, another possible cause of cognitive impairment in heart failure is decreased cerebral perfusion. Systolic dysfunction of the left ventricle reduces …